• The Journal of the Korean bone and joint tumor society
• /
• v.5 no.1
• /
• pp.70-75
• /
• 1999

We present a case of parosteal osteosarcoma of the femur with secondary dedifferentiation. This 57-year-old woman was radiologically diagnosed as a parosteal osteosarcoma in 1987. In 1992, excisional biopsy revealed a classical parosteal osteosarcoma with diploidy DNA pattern. In 1998, she revisited due to a recurrent tumor with pathologic fracture. The resected specimen showed a classic parosteal osteosarcoma with area of dedifferentiation, showing high-grade spindle cell sarcoma. This dedifferentiated area revealed aneuploidy cell population on DNA flow cytometry. This case reminds us that not all parosteal osteosarcomas are low-grade lesions. Some low-grade lesions may dedifferentiate to become high-grade tumors after inadequate excision.

• The Journal of the Korean bone and joint tumor society
• /
• v.13 no.2
• /
• pp.195-200
• /
• 2007

Dedifferentiated parosteal osteosarcoma is an uncommon variant of osteosarcoma. Dedifferentiation is known to be associated with a greater metastatic potential and a more rapid lethal clinical course. Thus recognition of dedifferentiation is important to establish the treatment strategy. But there may be few significant clinical clues to distinguish between dedifferentiated parosteal osteosarcoma and conventional one. A 29-year-old woman presented with 2-year history of discomfort and swelling in her proximal thigh. Examination showed a large, hard, non-mobile mass. Radiographs revealed a large ossified mass attached to the proximal femur. Diagnosis of parosteal osteosarcoma was established by MRI and needle biopsy. But she had a history of abrupt severe thigh pain and increased swelling before surgery. Follow up MRI showed enlargement of mass with invasion to muscle around tumor. The patient underwent an en-bloc resection of tumor and reconstruction. Histological examination showed parosteal sarcoma with dedifferentiation. The patient expired due to local recurrence of tumor and distant lung metastasis 2 months after the surgery. In case with rapid growth of a lesion or unusual severe pain, one must have a high index of suspicion with regard to dedifferentiation.

• The Journal of the Korean bone and joint tumor society
• /
• v.19 no.1
• /
• pp.20-27
• /
• 2013

Purpose: The purpose of this study was to evaluate the oncologic outcomes of parosteal osteosarcoma (POS) and to ascertain the fates of patients after local recurrence (LR). Materials and Methods: The authors retrospectively reviewed 22 POS patients with an average follow-up of 114 months (range: 36-235 months). Seven of the 22 patients were referred after LR. There were 17 Stage IB and 5 Stage IIB (G2, 2; dedifferentiation, 3). Tumors were located in the femur (11) and in other locations (11). Initial surgical margins were wide in 10, marginal in 5, and intralesional in 7. Correlations between clinico-pathologic variables and LR and clinical courses after LR were evaluated. Results: The 10-year overall survival rate was 85.7%. Three (14%) patients developed distant metastasis and all of them succumbed to the disease. Nine (41%) patients developed LR. Tumor location, resection type, and surgical margin were found to be correlated with LR. At final follow-up, 7 of the 9 patients that experienced local failure achieved no evidence of disease. Conclusion: A substantial risk of misdiagnosis exists, especially for POS in other than a femoral location. Recurrent tumor re-excision is possible in most cases; however, patients with an aggressive recurrence pattern deserve special attention.

• The Journal of the Korean bone and joint tumor society
• /
• v.16 no.2
• /
• pp.95-98
• /
• 2010

Synovial chondromatosis is a benign nodular cartilaginous proliferation arising in the synovium of joints. The radiolographic features of this condition are variable. Rarely, it would be confused with malignancy such as chondrosarcoma, osteosarcoma or synovial sarcoma. We report a case of primary synovial chondromatosis of the posterior aspect of the proximal tibia mimicking a parosteal osteoarcoma on the radiography, which showed a homogeneously radiopaque juxtacortical mass. However, subsequent computed tomography (CT) showed multiple intra-articular masses containing chondroid mineralization, suggesting synovial chondromatosis.

• The Journal of the Korean bone and joint tumor society
• /
• v.8 no.1
• /
• pp.32-37
• /
• 2002

High grade surface osteosarcoma is the most rare subtype of osteosarcoma arising on the surface of bone, accounting for less than 1% of the total number of osteosarcomas. Only a few case reports and studies have been reported in the world. In Korea, only one case out of 127 osteosarcomas has been described up to now, but there was no information about the patient, clinicopathologic features and treatment. We experienced a case of high grade surface osteosarcoma in the subtrochanteric area of a 66-year-old female and treated her with neoadjuvant chemotheraphy, wide resection and limb salvage operation with tumor prosthesis and adjuvant chemotheraphy. This tumor is identical to conventional high grade intramedullary osteosarcoma in histology, treatment and prognosis. So, this tumor should be differentiated from other surface osteosarcomas such as parosteal osteosarcoma and periosteal osteosarcoma.

• The Journal of the Korean bone and joint tumor society
• /
• v.5 no.3
• /
• pp.162-168
• /
• 1999

The products of c-fos and c-jun proto-oncogenes form the heterodimeric complex activator protein 1 (AP-1), which plays an important part in the control of bone cell proliferation and differentiation, as well as in the development of bone tumors. The expression of c-fos protein was examined in 35 cases of human osteosarcomas as formalin-fixed paraffin-embedded tissue sections using a monoclonal antibody. The expression of c-fos was restricted to bone-forming lesions, while low grade cartilaginous tumors were devoid of immunoreactivity. The highest levels of c-fos expression were detected in osteoblastic osteosarcoma (13 of 17 cases with grade one on two) while two chondroblastic osteosarcomas, one fibroblastic osteosarcoma, and two parosteal osteosarcomas were negative. Two cases of telangiectatic osteosarcomas were positive for c-fos protein. However, since there is a tendency of high c-fos protein expression at the higher histological grade, significant differences were not present in the expression of c-fos protein. Thus c-fos expression may be implicated in the development of osteosarcomas, but they appear to have little or no relevance in the development of low grade cartilaginous neoplasms.

• The Journal of the Korean bone and joint tumor society
• /
• v.14 no.2
• /
• pp.178-181
• /
• 2008

In contrast to ganglion of the soft tissue, periosteal ganglion occurring within or beneath the periosteum is a rare disorder. The differential diagnosis includes periosteal chondroma, lipoma, giant cell tumor of tendon sheath and periosteal osteosarcoma. Most common location for periosteal ganglion is the tibia, followed by radius, femur and ulna. To our knowledge, only 1 case of periosteal ganglion of the fibula has been reported in the literature. We report a case of periosteal ganglion of the distal fibula in a thirty-year-old woman treated with excision of the cyst and the adjacent periosteum.

• The Journal of the Korean bone and joint tumor society
• /
• v.4 no.1
• /
• pp.59-64
• /
• 1998

Parosteal osteosarcoma is characterized as a densely ossifying lesion, usually occurring on the surface near the metaphyses of a long bone. The histological pattern is a well- differentiated mature bone trabeculae with a hypocellular spindle-cell stroma. The cytological details are those of a low-grade malignant lesion. The natural history of this lesion is indolent local growth, late invasion of the underlying bone, and infrequently, distant metastasis. However, there is a significant risk of eventual dedifferentiation into a high-grade lesion. We report here-a case of parosteal osteosarcoma dedifferentiated into a high-grade lesion, which occurred in the left distal femur of a 40-years-old woman, and discuss the experience in detail.

• The Journal of the Korean bone and joint tumor society
• /
• v.1 no.1
• /
• pp.30-37
• /
• 1995

The prognosis of parosteal osteosarcoma is better than any other malignant bone tumors, but there are many controversies in its treatment. We tried to evaluate the prognosis and the effectiveness of limb-salvage operation in the treatment of the parosteal osteosarcoma. We experienced 12 patients of conventional parosteal osteosarcoma(2 males and 10 females) from 1981 to 1991. The limb-salvage operations with wide resection margin were done in 8 patients(5 tumer prosthesis, 2 resection arthrodesis and 1 vascularized fibular transplantation), marginal en-bloc resection and amputation in 2 patients, respectively. The duration of mean follow up was 5 years and 9 months, ranging from 2 year-3 months to 11 years, except of the patient who died with metastasis 1 year 8 months after. The disease-free survival rate(DFSR) of all patients was 68% and that of the patients treated with limb-salvage operation was 88% at 7 years. The DFSR was 33% with marginal margin(3 cases) and 89% with wide margin(9 cases) at 7 years. The results were unsatisfactory in the conventional parosteal osteosarcoma treated with marginal resection. The limb-salvage operation with wide surgical margin was thought to be the treatment of choice.

• The Journal of the Korean bone and joint tumor society
• /
• v.16 no.1
• /
• pp.1-7
• /
• 2010

Purpose: With advances in various treatment modalities, limb salvage surgery has been commonly used in osteosarcoma of extremities. An alternative method for skeletal reconstruction is reimplantation of the tumor bearing bone following extracorporeal irradiation (ECI). We report the long-term results of ECI autograft in aspect of the oncological and functional outcomes, and complications. Materials and Methods: We retrospectively reviewed 31 osteosarcoma patients who underwent reconstruction with ECI between July 1995 and January 2006. There were 24 males and 7 females with a mean age of 24 (7-74 years) and a mean follow-up of 117 months (17-177 months). Twenty-five cases were reconstructed with ECI autograft, 6 cases with ECI autograft-prosthesis composite. The pathologic subtypes were conventional in 29 cases, periosteal in 1 case, and parosteal in 1 case. The most common location of tumor was distal femur (15 cases) followed by humerus (3), proximal fibula (3) and proximal tibia (3). Musculoskeletal Tumor Society (MSTS) score was used for functional evaluation. The overall survival rate, local recurrence, complications were analyzed. Results: The overall survival rate was 80.6% and the disease-free survival rate was 64.5%. Five patients died of distant metastasis. One patient required above-knee amputation due to local recurrence. All of them, twenty-three complications occurred, which included nonunion in 7 cases, deep infection in 5 cases, joint instability in 4 cases, metal failure in 2 cases, Limb-length discrepancy (LLD) in 2 cases, periprosthetic fracture in 1 case, epiphyseal collapse in 1, local recurrence in 1 case. The mean MSTS functional score was 62.5%. Conclusion: Extracorporeal irradiated autograft can be achieved relatively good result in aspect of oncological and functional aspect, but is needed to be additional research about occurring many complications. The reconstruction with ECI after intercalary or fragmentary resection is effective reconstruction in aspect of oncological and functional result, complications.